Gao Bo, Zheng Naiquan Nigel
Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.
Clin Biomech (Bristol). 2010 Mar;25(3):222-9. doi: 10.1016/j.clinbiomech.2009.11.006. Epub 2009 Dec 14.
High risk of cartilage degeneration and premature osteoarthritis development has been clinically observed in anterior cruciate ligament (ACL) deficient knees. The risk has not been significantly reduced even after ACL reconstructive surgery. It was hypothesized that three-dimensional knee joint kinematics has been altered after ACL injury, and the biomechanical alteration has not been fully restored to a normal level after reconstructive surgery.
Spatiotemporal parameters and three-dimensional knee joint rotations and translations were measured in ACL-deficient, ACL-reconstructed, and ACL-intact knees during level walking. The variables were compared between the ACL-deficient and ACL-intact knees, as well as between the ACL-reconstructed and ACL-intact knees.
Altered spatiotemporal variables and key event timings in a gait cycle were observed in both ACL-deficient and ACL-reconstructed subjects. Significant reduction of extension was observed in the ACL-deficient knees during midstance and in the ACL-reconstructed knees during swing phase. Greater varus and internal tibial rotation were identified in the ACL-deficient knees. Although being small in magnitude, these secondary kinematic alterations were consistent throughout the whole gait cycle, and such trends were not eliminated in the ACL-reconstructed knees.
Significant abnormalities of spatiotemporal performance and three-dimensional joint kinematics during walking were identified in the ACL-deficient knees. The ACL-reconstructed knees exhibited some improvement in joint kinematics, but not being fully restored to a normal level. Identification of biomechanical alterations during daily activities in ACL-deficient and ACL-reconstructed knees could help better understand clinical outcomes and seek improvement in surgical technique and rehabilitation regimen for ACL injury treatment.
临床上观察到，前交叉韧带（ACL）损伤的膝关节存在软骨退变和过早发生骨关节炎的高风险。即使进行了ACL重建手术，这种风险也没有显著降低。据推测，ACL损伤后膝关节的三维运动学发生了改变，而重建手术后生物力学改变并未完全恢复到正常水平。
在平地上行走时，测量ACL损伤、ACL重建和ACL完整的膝关节的时空参数以及三维膝关节的旋转和平移。比较ACL损伤膝关节与ACL完整膝关节之间以及ACL重建膝关节与ACL完整膝关节之间的变量。
在ACL损伤和ACL重建的受试者中均观察到步态周期中的时空变量和关键事件时间改变。在支撑中期，ACL损伤的膝关节伸展明显减少，在摆动期，ACL重建的膝关节伸展明显减少。ACL损伤的膝关节内翻和胫骨内旋更大。尽管这些继发性运动学改变幅度较小，但在整个步态周期中是一致的，并且在ACL重建的膝关节中这种趋势并未消除。
ACL损伤的膝关节在行走过程中存在明显的时空表现和三维关节运动学异常。ACL重建的膝关节在关节运动学方面有一定改善，但未完全恢复到正常水平。识别ACL损伤和ACL重建膝关节日常活动中的生物力学改变，有助于更好地理解临床结果，并寻求改善ACL损伤治疗的手术技术和康复方案。
